Protein-energy wasting syndrome in advanced chronic kidney disease: Prevalence and specific clinical characteristics

Abstract

IntroductionProtein-energy wasting (PEW) is associated with increased mortality and differs depending on the chronic kidney disease (CKD) stage and the dialysis technique. The prevalence in non-dialysis patients is understudied and ranges from 0 to 40.8%. ObjectiveTo evaluate the nutritional status of a group of Spanish advanced CKD patients by PEW criteria and subjective global assessment (SGA). Patients and methodsCross-sectional study of 186 patients (101 men) with a mean age of 66.1±16 years. The nutritional assessment consisted of: SGA, PEW criteria, 3-day dietary records, anthropometric parameters and bioelectrical impedance vector analysis. ResultsThe prevalence of PEW was 30.1%, with significant differences between men and women (22.8 vs. 33.8%, p<0.005), while 27.9% of SGA values were within the range of malnutrition. No differences were found between the 2 methods. Men had higher proteinuria, percentage of muscle mass and nutrient intake. Women had higher levels of total cholesterol, HDL and a higher body fat percentage. The characteristics of patients with PEW were low albumin levels and a low total lymphocyte count, high proteinuria, low fat and muscle mass and a high Na/K ratio.The multivariate analysis found PEW to be associated with: proteinuria (OR: 1.257; 95% CI: 1.084–1.457, p=0.002), percentage of fat intake (OR: 0.903; 95% CI: 0.893–0.983, p=0.008), total lymphocyte count (OR: 0.999; 95% CI: 0.998–0.999, p=0.001) and cell mass index (OR: 0.995; 95% CI: 0.992–0.998). ConclusionMalnutrition was identified in Spanish advanced CKD patients measured by different tools. We consider it appropriate to adapt new diagnostic elements to PEW criteria.